Fiorentini Sandra Flavia, Khurram Darakhshanda
Moorfields Eye Hospital Dubai, United Arab Emirates.
Saudi J Ophthalmol. 2019 Apr-Jun;33(2):117-120. doi: 10.1016/j.sjopt.2019.04.001. Epub 2019 May 17.
The purpose of this paper is to review the efficacy and safety profile in children treated with topical 0.03% Tacrolimus ointment for vernal keratoconjunctivitis in Middle East and to propose a treatment posology. According to recent studies, a complex non-IgE dependent mechanism plays a relevant role in the pathogenesis of vernal keratoconjunctivitis. Numerous cells and mediators have been found in the serum, conjunctiva and tears of patients with Vernal keratoconjunctivitis.
This case series included 10 patients from a single centre, pediatric department of a tertiary hospital with active symptomatic vernal keratoconjunctivitis. All the patients had proliferative lesions and corneal involvement despite conventional medications, including topical steroids. All other medications, systemic and topical: steroids, antihistamines and cyclosporine, were unsuccessful. Patients were treated with topical 0.03% Tacrolimus ointment twice daily for 8 weeks and then once a day for the next two month followed by thrice a week for two months. The changes in symptoms and signs after treatment were evaluated, also the development of possible complications was assessed.
The results showed a significant reduction in signs and symptoms after 4 weeks of the treatment. Clinical resolution of giant papillae and corneal lesions were seen within eight weeks and no additional drug was required during that period, except tear substitutes. Treatment was continued for period of two months and then slowly reduced.
The use of 0.03% Tacrolimus ointment is safe and effective in children refractory to conventional treatment of vernal keratoconjunctivitis even in high temperature climate as Middle East. Due to the effectiveness of the treatment, the dosage used may be proposed for conventional use.
本文旨在回顾中东地区使用0.03%他克莫司软膏局部治疗春季角结膜炎患儿的疗效和安全性，并提出治疗剂量。根据最近的研究，一种复杂的非IgE依赖机制在春季角结膜炎的发病机制中起重要作用。在春季角结膜炎患者的血清、结膜和泪液中发现了许多细胞和介质。
本病例系列包括来自一家三级医院儿科单一中心的10例有症状的活动性春季角结膜炎患者。尽管使用了包括局部类固醇在内的传统药物，但所有患者均有增殖性病变和角膜受累。所有其他药物，包括全身和局部使用的类固醇、抗组胺药和环孢素，均治疗失败。患者每天两次外用0.03%他克莫司软膏，持续8周，然后接下来两个月每天一次，随后两个月每周三次。评估治疗后症状和体征的变化，同时评估可能并发症的发生情况。
结果显示治疗4周后体征和症状显著减轻。8周内可见巨大乳头和角膜病变的临床消退，在此期间除泪液替代物外无需使用其他药物。治疗持续两个月，然后逐渐减量。
即使在中东高温气候下，对于传统治疗无效的春季角结膜炎患儿，使用0.03%他克莫司软膏也是安全有效的。鉴于治疗效果，可以推荐使用该剂量用于常规治疗。
